Healthcare Provider Details

I. General information

NPI: 1124382791
Provider Name (Legal Business Name): TIFFANY LYNN GODLOVE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

IV. Provider business mailing address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-4360
  • Fax: 513-233-4361
Mailing address:
  • Phone: 513-233-4360
  • Fax: 513-233-4361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.013682
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.003280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: